Women and pills have a long, troubled history.
From opiates like morphine and laudanum, which were used as painkillers and to mitigate anxiety in the nineteenth century, to contemporary psychiatric medication, women have always been more likely to be prescribed, to take, and to suffer from addiction to drugs.
There is some gender bias at play here, but it does not always manifest in the ways we might expect: for example, women are more likely than men to suffer from depression, but a woman is also twice as likely to receive a diagnosis of depression as a man presenting with identical symptoms; women are also more likely to be prescribed medication to treat depression. The World Health Organisation concludes, simply, that,
“Female gender is a significant predictor of being prescribed mood altering psychotropic drugs.”
Furthermore, women have always been more predisposed than men towards substance abuse: the WHO notes that “depression, anxiety, psychological distress, sexual violence, [and] domestic violence […] affect women to a greater extent than men across different countries and different settings”, and that there is a clear correlation between social factors such as gender discrimination, sexual assault, violence, overwork, poverty, malnutrition, and trauma – which are all more likely to affect women than men – and mental illnesses. Gender differences in body composition, hormones, and metabolism may make women more sensitive to certain medications – but we don’t know for sure, because women were banned from participating in clinical drug trials in the USA until the 1990s. There is a distinct lack of data on the effects of many common medications on women, but it seems generally apparent that women are more sensitive to most drugs (and are between fifty and seventy-five percent more likely to experience side effects). This isn’t even taking into consideration the potential interactions between, say, a psychotropic medication which has been tested only on (cisgender) men, and things like hormonal contraception or hormone replacement therapy, which form no part of clinical drug trials.
There is a distinct lack of data on the effects of many common medications on women, but it seems generally apparent that women are more sensitive to most drugs
In addition to psychiatric problems and treatments, women’s physical health conditions are overlooked or not taken seriously by the medical community – illnesses like endometriosis, which are estimated to affect 200 million women worldwide, go undiagnosed for years because women’s pain is routinely dismissed by their doctors. Many women suffer through debilitating menstrual cramps and menopause symptoms, not to mention pregnancy and birth, with few truly effective treatment options – despite the fact that women have been having periods and giving birth for a while now. So, to sum up: women are more likely to experience psychological and physical distress; we are more likely to be prescribed medication for that distress; we are more likely to have a strong reaction to the treatment, and to suffer side effects; and – while we are less likely than men to actually become addicted – our addiction is more harmful, escalates faster than male addiction, and is harder to recover from (this is, again, possibly due to different body chemistry: levels of glucose, a carbohydrate which is vital in maintaining self-control, fluctuate at different points in the menstrual cycle).
There is something about women that we want to control. Throughout western history, women’s lives have been restricted – from where they can go, via what they can do, to what they can wear (the corset is one heavy-handed, but nonetheless fitting, metaphor for female restriction; the gendered history of pockets another). In fact, the history of women’s clothing is the history of women’s imprisonment: how do you move freely around in a corset, ankle-length steel crinoline, seven layers of fabric, and high heels? (Especially if you have a handbag in one hand (because no pockets) and your skirts in the other so you don’t trip.) If you’re afraid of dirtying your expensive clothes, it’s safest to stay indoors. Indeed, fashion has been used not only to implicitly restrict women’s movement and confine them to the domestic sphere because of its impracticality; it has been explicitly utilised as a tool for women’s disempowerment, too.
in 1800, the French government issued an order forbidding women to wear trousers in public in Paris, prompting the female novelist George Sand (among others) to illegally disguise herself as a man so she could walk the streets. We might have left behind many of these sartorial tools of control (although the Paris law was only finally revoked in 2014), but women’s clothing remains primarily decorative, not practical: as recently as 2016, Kylie Jenner made headlines because of the injuries she sustained from her Met Gala dress. There’s no beauty without pain.
There is something about women that we want to control.
Evidently, we want women to conform to a number of very specific social roles. Women should be, primarily, in the home, confined to the domestic sphere. This is mostly true of upper-middle-class and upper-class women, for whom there is no financial imperative to go to work, and whose role therefore revolves around caring for their children, husband, and social circle – of course many women don’t conform to this white, affluent, heterosexual prototype, but the fact that it is still presented as aspirational for people of all races and classes is significant in terms of revealing what we, as a culture, value. Conventional femininity remains prescriptive and proscriptive: women should be seen (in certain places, at certain times, in certain attire, with certain bodies) and rarely heard.
Perhaps this is due to our obsession with what is “natural” – women who abandon the role of caregiver are abandoning their ordained position in a civilised society, abandoning the very history of humankind, by neglecting their “natural” nurturing instincts. However, we seem conflicted about what is really natural for women: pregnancy and motherhood are natural; menstruation is not. Ugly women are unnatural, because no men want to mate with them – but make-up and plastic surgery are unnatural, and the female obsession with clothes and appearance is routinely ridiculed. Body hair is natural, but must be removed. It seems that the “perfect woman”, were she to exist, would be entirely artificial: if Barbie were life-size and animate, her body is so out of proportion that she would be unable to walk. But any acknowledgement of the artifice and augmentation that go into the daily performance of femininity is forbidden.
Our conception of “natural” feminine behaviour is confused: women must be nurturing caregivers for children and their husbands, but they must also be less emotional than they are; we deride women who are vacuous or shallow, but demand that they falsify much of their appearance, behaviour, and thoughts in order to attract men.
It is this contradictory state of play that is, at least in part, to blame for women’s historic relationship with drugs. The confusion of natural and unnatural, the need to be present and absent simultaneously; these pave a clear path towards artificial tools (medication, surgery, supplements, ointments, make-up, magazines that teach you how to behave) as a solution to women’s plight, a quick fix for the problems with your appearance or personality or health. The prevalence of drugs and alcohol in the lives of middle-class British and American women over the last two hundred or so years is significant, indicating that there has always been a need for women to increase or suppress something – or several things – about themselves in order to function. As historian David Herzberg says, “One of the functions of our medical system since it has organised itself has been to hand out stimulants and sedatives to American women.”
Words: Nicola Watkinson
Illustrator: Esme Blegvad